Notice of Retraction: March 2, 2022
We regret to inform you that The Journal of Bone and Joint Surgery must retract the article entitled “Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment” by M. Tahir, E.A. Chaudhry, N. Ahmed, A.H. Mamoon, M. Ahmad, A.R. Jamali, and G. Mehboob. The citation for this article is J Bone Joint Surg Am. 2021 Mar 3;103(5):397-404.
JBJS was alerted to potential issues with the article following the retraction of a previously published article by the lead author in a separate journal. The lead author was then asked to provide the raw data for the study that appeared in JBJS. A review by several members of the JBJS Editorial Board and copy-editing department revealed a number of inconsistencies between the raw data and the published data. The lead author was unable to provide a satisfactory explanation regarding these inconsistencies, the data-collection process, and the study design. After careful consideration, it was decided that retracting the original article was appropriate.
Marc F. Swiontkowski
OrthoBuzz previously covered WALANT (wide awake, local anesthesia, no tourniquet) surgery, and we very recently featured a JBJS study about treating ankle fractures in a limited-resource environment. These 2 concepts unite in a JBJS study by Tahir et al., which reports on WALANT surgery for ankle fractures in Pakistan.
WALANT surgery has enjoyed increasingly broad dissemination throughout the world since its popularization by Canadian hand surgeon Don Lalonde. Considering its origins, WALANT has been adopted most enthusiastically by the hand-surgery community, but it has been applied successfully to other anatomic regions. WALANT principles are particularly relevant in settings where anesthetic resources and expertise may be limited, such as hospitals where monitoring equipment that helps ensure safe general anesthesia is not readily available.
Tahir et al. used WALANT during open reduction/internal fixation (ORIF) in 58 patients (average age of 47 years) with a distal fibula fracture; 62% of those fractures were OTA-classified as 44C2. Among the excellent results in this cohort were a mean intraoperative VAS pain score of 1.24 and a mean operative time of <1 hour. These findings point to the potential for safely using WALANT techniques during ORIF of other fracture types.
The authors emphasize, however, that “each patient should be individually assessed by the operating surgeon,” not only for injury characteristics that contraindicate WALANT, such as substantial swelling, but also for anxiety and psychological disorders. Consequently, Tahir et al. recommend that surgeons undertaking WALANT procedures have a backup anesthetist available so they can convert to general anesthesia in cases of patient anxiety.
Marc Swiontkowski, MD